The bill amends section 3902.50 of the Revised Code and enacts a new section, 3902.80, to establish regulations regarding the use of artificial intelligence (AI) by health insurers in Ohio. The amendment to section 3902.50 involves the deletion of the reference to section 3902.72 and its replacement with section 3902.80. The new section outlines definitions and requirements for health plan issuers, including the obligation to report annually on their use of AI in utilization review processes. This report must include details such as the criteria for algorithms used, data sets for training, and outcomes of the AI applications.

Additionally, the bill prohibits health plan issuers from making decisions about a covered person's care based solely on AI-derived results. It mandates that determinations of medical necessity must involve a licensed physician or qualified provider who considers the individual circumstances of the covered person. Any decisions made using AI must be accompanied by a clear explanation of the rationale. The superintendent of insurance is granted the authority to audit the use of AI by health plan issuers and may engage third parties for this purpose. The provisions of this section apply to health benefit plans issued or renewed after the effective date of the bill.

Statutes affected:
As Introduced: 3902.50